Good bye and good luck

August 10th, 2010 by MSF Field Blog

The end of a mission means writing a report of what you did and what’s left to do. But it’s also a time when I do my own self-assessment, and as before, I find I’ve gained skills outside my job description. I can catch mice with an old fashioned mouse trap (use peanuts); I’ll use the radio alphabet when spelling my last name on the phone (alpha, lima, tango, hotel, Oscar, Mike…); the key to lighting a gas heater is to strike the match BEFORE turning on the gas; I can read Russian!

Again I feel myself changed. I’m even more appreciative of small things (water pressure!), but perhaps have less tolerance for BS. I’ve been given loads of opportunities to practice patience, and I’m getting better at it. I still believe in a better world, but I’m becoming more realistic about how to get there, and how long it may take. One thing’s for certain, we can definitely go further – together.

Happy Birthday Sandy

July 30th, 2010 by MSF Field Blog

It’s 9:10am and our data assistant still hasn’t reported for duty. My database manager tried to call her mobile phone, but it’s not working. Just as I begin to worry, the door opens and she walks in with a bouquet of flowers.

“Happy Birthday Sandy!” That’s how you should walk in when you’re late.

I like having my birthday in the field. The field is an incubator for making fast friends, an instant family. Simple gifts are relished more than elaborate ones. This year my birthday coincided with my last monthly staff meeting. It was also the last one for two young women headed to the States on a scholarship. We celebrated with grilled meat (shashliek), ice cream, beer and soda. I suppose that’s a bit elaborate.

Next week is my last real working week. Sometime the following week my successor will arrive and I will spend my time handing over these duties to her. While I’m trying to finish as much as I can, I’m realizing there’s more to put on her plate. It’s a guilty feeling, one of not finishing what I started. But I suppose this is the nature of MSF. In the end, we are all standing on the shoulders of those who came before. I hope she gets a clearer perspective from up there.

Extra Work

July 7th, 2010 by MSF Field Blog

After 4 months in Nukus, no one asks me if I’m Indian anymore. Complete strangers now approach me with a one-word question. “America?” I guess word has gotten around. Perhaps if I stayed another 4 months, they’d even know my name. Instead, my end of mission is quickly approaching and I’m trying to stick to my schedule for the next few weeks.

I spent the last two days training government doctors how to document information about their patients on new forms. When presenting a new idea to a roomful of post-Soviet doctors who speak Russian, learn to trust your translator. I thought I was being smart by handing out monthly reports for the last 3 months. It was my offering of shared knowledge; information shouldn’t only go up the hierarchy. But this new system would mean that the doctors would have to collect the data, fill in the forms, do something outside the current task list; which they were not particularly excited about. I spent 20 minutes listening to them telling me about their already heavy work load and responsibilities.

I tried to explain that this information will help them with patient care, that they can see how the whole program progresses, that they can monitor the proportions of patients with drug resistance. Their attitude towards data collection can be summarized by the comment form one older doctor, exclaiming. “We’re just workers here, we take orders.”

How does one say, “me too” in Russian?

I just wanted to get through my agenda, but I was feeling more and more like the typical foreigner who comes to a developing country to implement some grand idea quickly and leave behind more work. I could see their point. Our MSF drivers probably make more than they do, and here I was, representative from this rich organization, asking them – no, telling them to do more.

I suppose it’s inevitable. MSF has taken on much of the responsibilities for drug resistant TB control in this region. But eventually MSF will leave, because MSF is always supposed to eventually leave. And when MSF leaves, the government doctors have to take on additional tasks. But this transition is painful. Now it seems like my biggest job is not testing the new database or migrating data from the old to the new. I have to sell epidemiology to these doctors. I have to get them to see that this information is vital for understanding how well the program is doing, and that it can only be accomplished if they participate. I have to take off the epidemiologist hat and put on the salesman hat.

Because when I leave, I don’t want to be known as that “American” who left behind more work.

Fourth and last day in Andijon

June 20th, 2010 by MSF Field Blog

Fourth and last day in Andijon. Our skeletal team will remain while they await reinforcements from Amsterdam, but it’s time for me and my database manager to go back to our chronic crisis in Nukus. We’re sitting in the Andijon airport and expecting lots of people because there are 4 planes on the tarmac. But as I look closer, only one is a passenger plane, the others are cargo planes (no windows).

As we fly to Tashkent, I imagine we cross the Kyrgyz-Uzbek border, multiple times. We had arrived in Andijon by car from Tashkent. We took a road that cut through the mountains –through two tunnels. During Soviet times people used another road that cut straight across, because there were no borders. That road is in disrepair now as it’s never used. The older people I’ve talked to recount that these conflicts at borders never happened during Soviet times. I don’t think they’re yearning for the previous system. But perhaps it’s a recognition that different types of people lived here together long before the lines were drawn.

Third day in Andijon

June 19th, 2010 by MSF Field Blog

Third day in Andijon. We visit one more camp, and I look for the senior Epidemiologist whom I’m told is here. After our discussions I try to offer any assistance or support but the response is a simple, “Thank you for coming.” It’s clear we can’t do our own independent assessment, so there’s little need for me here. I have heaps to do back in Nukus (less than 2 months left in my mission), so I need to get back. We make arrangements to get the next plane to Tashkent and I offer to help take inventory of the emergency box of supplies we brought with us from Nukus. I want to do something useful while here.

Second day in Andijon

June 18th, 2010 by MSF Field Blog

Second day in Andijon. We meet a larger group of UN staff from different agencies; everyone has their t-shirts on – UNHCR, WFP, UNFP, OCHA – alphabet soup. We’re supposed to assist in a qualitative assessment. We’ve been allowed to enter camps and talk to refugees. Though I’m not completely okay with the survey model, I don’t want to miss the opportunity to have individual conversations. First we went to the border crossing at Yor Kishlok. The place was completely deserted. The border guards told us they closed the border on June 10 and never reopened it. My eyes followed the border crossing as it became a fence and split a village in half. These borders were designated by men sitting in offices in a country far from here by who knows what means; they obviously didn’t take into consideration the population that live here.

We went to a camp that wasn’t far from the border – again loads of military and road blocks control what little traffic is moving about, mostly white land cruisers. As we entered the camp, an Uzbek television crew followed us. I approached one of the UN officials on my team and asked why he was being allowed to record our interviews as these could be highly personal, tragic, and even contentious. She tells me it’s not our choice to make. A bad feeling starts to rumble inside me.

We’re introduced to the woman managing the camp, and begin to enter the area where the tents are set up. We are immediately approached by two women who want to tell us what was happening in Osh. Three more women join, some children, then even more women. Soon my translator and I are surrounded by over a dozen women, two or three talking at the same time. My translator desperately tries to keep up with the women who are outraged at their situation and pleading with me – the foreigner – to help them. They recount terrible stories of traumatic events experienced. I’m stunned for minutes, frozen in place, and then I see the camera man. I give him a look and wave my hand in front of my face, ‘Don’t do this,’ I try to pantomime. My translator is using a monotone voice to repeat what these women are saying, but she’s hearing it first hand, with all the emotion, anger and frustration in recounting the horror that they experienced on the other side of the border. Somehow I managed a sentence or two, “We are praying for you,” I begin, with my right hand on my heart, “but we are here to make sure your needs are met within this camp.” I am flooded with a barrage of reassurances that they are fine, that the Uzbek government has been taking good care of them, that they have everything they need, but it’s their husbands and brothers on the other side who need help. They wanted me to give them assurance that they can return to a peaceful country, where they will be safe. A guarantee. I suppose this is the fundamental human need – safety.

It was impossible for us to do any kind of assessment, and somehow we managed to break away from the circle that was rapidly enclosing us. We walked the perimeter of the camp; it was originally a summer camp for children and was very well maintained, in perfect condition. There are fewer people here than in the camps we visited yesterday. My translator is a bit traumatized and I know there’s no chance of getting any real information so we head for the car. We’re stopped by the woman managing the camp who wants to know why we are leaving so soon. I tell her that we have to summarize our information, but she’s holding a blue spiral bound booklet and wants to show us. There are digital images that have been compiled – four pictures on a page, and pages and pages of them. They’re awful. Dead bodies, some burned. I pull my translator away, she didn’t sign up for this. The camp manager tries to explain to me the atrocities of these photos. She seems almost numb.

We sit in the car and wait for the rest of the team. A huge entourage of 7 or 8 SUV’s drives by, circles, then lines up and parks at the entrance of the camp. The first car has an American flag. The rumbling feeling inside sinks and takes my stomach with it. I want to know who is visiting. There are heaps of media everywhere too. Thirty minutes later, a crowd emerges from the camp and I see a very tall man surrounded by people as he strides along. I can tell he’s the important one because he doesn’t have any notepads, phones or Blackberries. I assume the American ambassador is here, but it seems like a lot of attention for just the ambassador. It must be somebody bigger. He’s followed by a crowd of people, many with cameras. After they’ve all walked by, the SUV’s start their engines and slowly follow. I assume the important person is walking to get a photo-op, those of us working in the field are trying to limit our time in the hot sun. Three CNN guys return and stop to ask me about MSF, and tell me that the VIP is Assistant Secretary of State Robert Blake. I wonder if the women in the camp asked him for the same guarantee they asked me. I wish I could say something to the Assistant Secretary. He drives by with his motorcade and I hold up the peace sign. I don’t even know if he saw me.

First day in Andijon

June 17th, 2010 by MSF Field Blog

First day in Andijon. We arrived by car at the airport because it is the command central point for all the international agencies offering help. Of course the first thing we want to do is assess the situation, and we are offered a ministerial official to escort us to two camps. I’m hesitant that we can’t see a map or listing of camps and select one at random, but we are guests in this country, and it seems they have the capacity to manage this crisis.

The two camps we see are well managed and organized. People have bottled water and there seems to be sufficient tent shelters and pit latrines. These are emergency needs. It’s only been a few days since the violence erupted and I’m sure people need mental health support as well. I’m introduced to the head epidemiologist at the first camp, and he walks us around, pointing out water sources and calling children to show me their stained pinky fingers demonstrating they’ve received a polio vaccination. I voice my concern about vaccinations for measles and whether there is a mechanism to report diseases to a central level to monitor any potential epidemics. My guide is more interested to show me how well everything is running. We’re communicating through my database manager who is acting as a translator. I try to connect with him by explaining my background; that I was in Karakalpakstan when this emergency occurred, and that I’m not here checking on him, but rather offer any assistance I can. He’s looking at me as my words are translated. He has bags under bloodshot eyes. I’m sure he hasn’t slept for days. I ask him when this cotton factory (currently not in use) was converted to the camp and he has to think, forgetting what day it is, he recalls four days. I ask him if he’s slept much and he stares at me then points at his face, “Can you tell?”
I don’t have any official numbers with me when we leave. I’d rather go around and count for myself, but we have to see one more camp before returning to the command center to meet the other stakeholders. We’ve already spent too much time here. The next camp is supposed to be 10 kilometers away, but it seems like more. We drove through road blocks guarded by soldiers. The area feels like it’s in lockdown.

The World’s Watching

June 16th, 2010 by MSF Field Blog

My favorites are doing well, but I don’t know who to root for next week when Ghana plays Germany. I suppose either way I’ll have picked a winner. Uzbekistan isn’t even playing, but the World Cup is the topic of conversation at the beginning of the day, at lunch and as we all rush home to catch the early game. I like the World Cup; somehow it feels more global than the Olympics. And the world is watching.

The world is watching Uzbekistan now too. With our neighbor, Kyrgyzstan trying to preserve its democracy, they report that people are killed indiscriminately in the southern part of the country. Hundreds have been killed, and refugees have been pouring into Uzbekistan. I suppose it’s confusing for anyone not living here, but all of these Central Asian former Soviet countries have many ethnic groups living within their predefined borders. People normally get along. But when economies are troubled, governments undergo change, or people are angry about their immediate circumstance, often immigrants are looked at as scapegoats. It happens the world over. But things are never black and white. There are no winners and losers, or perhaps only those losing life and homes.

MSF has missions in both countries, but both of these missions focus on treating patients with TB. Now we’ll both have to consider the humanitarian crisis happening between us. Meanwhile our own chronic crisis of TB continues, and I need to finish implementing a new data collection system in our expanded sites. Today I’ll finish training doctors in using new forms, then hop a plane headed for the Fergana Valley to assess the situation. I had hoped to watch football games this evening – watching winners and losers is easier to understand.

Travels and the World Cup

June 9th, 2010 by MSF Field Blog

It’s hot. Someone told me it was 43 degrees today. I’m an American, so I had to Google 43 centigrade and convert it to Fahrenheit – 104°F. And it’s only June. Fortunately my office has AC, so I’ll try not to complain too much as I remember fellow MSF’ers who are sitting in the shade somewhere in Sudan and hoping it’s only 40°C.

I came back from holidays last week and quickly plunged back into the pile of data awaiting my return. Note to self: don’t return on the first week of the month when monthly reports are due. Holidays were a chance to decompress from the pressures at work, as well as check out the country I’ve called home for the last 4 months. Our doctor from Kyrgyzstan and I took the train to Samarkand – even the name evokes images of Silk Road mystic and wonder. As old as it is (more than 2500 years?), they’ve cleaned up the place and polished the mausoleums, mosques and madrassahs. It’s a place unlike any I have ever been. I’m at a loss for words so I hope the photos get through.

After a weekend in Uzbekistan’s historic city, we flew to the ancient city of Istanbul, which was named “Constantinople,” and before that “Byzantium.” We wanted to be in the city that straddles two continents, to see the Aya Sofia and Blue Mosque, to eat fresh grilled fish, and to feel the famous welcome of the Turkish people. But truthfully, we also went to shop in the malls. Lame, I know, but I still relished sitting in a movie theatre and buying new clothes.

Now I’m back, with a timeline to finish implementing a new information system before my end of mission. I’ve got a renewed perspective, and hopefully enough energy to get through these final hectic months. Holidays are good for that, and I’ll never understand why Americans don’t get more time.

Americans are also probably the only people not currently consumed by the World Cup either, but I have my favorites (Mexico, Argentina, USA, Ghana, Germany and Brazil).

Five phrases overheard in Istanbul:
1. What exactly is supposed to be buried in Constantine’s Column?
2. Backgammon, anyone?
3. I think all taxi drivers drive like that.
4. What’s up with all the cats?
5. …. – speechless in the Aya Sofia.

No new tale to tell

May 16th, 2010 by MSF Field Blog

Last weekend a group of us made a trip to the Aral Sea. It was a chance to witness what brought MSF to Uzbekistan in the first place. Sunday morning I crawled from our tent to watch the sun emerge from what remains of the Aral Sea. I’d never seen a sunrise over water before. It’s a beautiful thing. Something so simple that happens every day.



Our trip started after lunch on Friday, heading north on the road to Kazakhstan. We stopped the night in Moynak, what used to be a port town. Only skeletal buildings remain of the fish canneries and shipping industries on which the town was built. Now there’s a ship cemetery in Moynak, where you can see rusted ships abandoned in the desert. To make it easier for tourists who make it this far (including UN Secretary General Ban Ki-Moon), the corroded carcasses have been dragged from where they remained on the sea floor and lined up like cars in a parking lot, or tombstones.

Ship cemetary

Ship cemetary

We stayed the night in a former MSF guesthouse, though there was no running water (I don’t think I’ll ever get used to the smell of a pit latrine). After breakfast we drove toward the vacant sea floor. As we left Moynak, the roads deteriorated from asphalt to gravel to tracks in the dirt, left behind by Lorries transporting materials to the scattered oil or gas excavation sites that have sprouted in the ever expanding desert. At 44.0731°N latitude and 58.4576°E longitude (our doctor has GPS on his phone) we stopped to stretch our legs and take a break from the rutted ride. There was nothing but sand in all directions, yet we knew the sea had been there because the ground was littered with seashells. We drove nearly 3 hours to reach the water, and the sea continues its retreat.

We camped on a plateau overlooking the eastern shore of the Aral Sea. A few meters from our camp, I sat on the edge of a cliff and looked out on bushes growing where fish used to swim. Small waves break on what’s now a silt beach. Walking to the water means stepping in the sand and sinking 6 inches into sludge. I don’t know what to think. Progress is a synonym for development, and development means more resources. The planet manages to compensate for all we’ve taken from it, but what’s the cost to ourselves? Somehow it all seems so complicated, yet obvious. The Jordan River is now drying up as it’s diverted for development projects. Turkey is planning to dam the Tigris River to generate more electricity. And in my home country we are in the midst of the most massive oil spill in our history.



The Aral Sea was the fourth largest inland body of water. Today the sea has dried up to 5% of what it was a generation ago because the rivers that feed it are diverted to irrigate cotton fields. Left behind are salt, sand, and other particles that are swept up and blown throughout the region, contributing to higher rates of respiratory infections, including TB, than in other parts of the country. The health care system wasn’t great to start with, and TB control suffered. In 2010 Karakalpakstan has one of the highest rates of drug resistant TB in the world.

After breakfast, we tore down camp, packed the truck, and headed home. I listened to my mp3 player on the way back, hitting repeat when Love and Rockets’ “No new tale to tell” played:

Our little lives get complicated;
It’s a simple thing.
Simple as a flower,
And that’s a complicated thing.